Objective: The number of admissions to the emergency department (ED) of elderly patients who reside in nursing homes
with a diagnosis of pneumonia continues to grow. This study was designed to assess factors that predicted mortality in the
patient group defined as those with nursing home-acquired pneumonia (NHAP).
Materials and Methods: This was a prospective, observational study conducted in a hospital ED. The data of nursing home
patients admitted to the ED with a pneumonia presentation (NHAP) were compared with those of patients with communityacquired pneumonia (CAP). Factors that predicted mortality in the NHAP group were analyzed. SPSS for Windows, Version
16.0 software (SPSS Inc., Chicago, IL, USA) was used to perform the statistical analysis.
Results: A total of 98 patients >18 years of age, 36 of whom were NHAP patients, were included in the research. The risk
level and rates of intensive care admission and mortality were significantly higher in the NHAP group (p<0.05), and the thiol
level, an antioxidant parameter, was lower in the NHAP group than that of the CAP group (p<0.001). Evaluation of the
NHAP group alone revealed a higher mortality rate in patients with congestive heart failure, those hospitalized in intensive
care, and those with high risk scores (p<0.05). The shock index (SI) value was found to be an independent predictor of mortality in the NHAP group. The study results indicated that each 0.1 unit increase in the SI increased mortality 3.637 times
(95% confidence interval: 1.024-12.921) (p=0.046).
Conclusion: The findings suggest that the SI could serve as a valuable marker for predicting mortality in NHAP patients.
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Esin ŞENOL ,
Aykut ÇİLLİ ,
Hakan GÜNEN ,
Alper ŞENER ,
Rıdvan DUMLU , Ayşe ÖDEMİŞ, Ayşe Füsun TOPÇU,
Yeşim YILDIZ ,
Rahmet GÜNER ,
Ayhan ÖZHASENEKLER , Birsen MUTLU, Nurdan KÖKTÜRK,
Nurgül SEVİMLİ ,
Nurcan BAYKAM ,
DERYA YAPAR ,
Selami EKİN ,
Mehmet POLATLI ,
Şebnem Eren GÖK ,
Oğuz KILINÇ ,
Abdullah SAYINER , Ömer KARAŞAHİN,
Çağlar ÇUHADAROĞLU , Ayşe Sesin KOCAGÖZ,
Turhan TOGAN ,
Hüseyin ARPAĞ ,
Hakan KATI , İftihar KÖKSAL,
Firdevs AKSOY , Canan HASANOĞLU
OBJECTIVE: To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients.MATERIAL AND METHODS: This multicenter, non-interventional, prospective, observational study included adult CAP patients (age ≥ 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia.RESULTS: Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P = .007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P = .235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P = .002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group.CONCLUSION: The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP.
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Objectives: To study changes in dynamic thiol/disulfide homeostasis (TDH) in patients with acute aortic dissection (AAD).Materials and Methods: In our study, the medical records of patients who applied to Ankara Atatürk Training and Research Hospital between January 2015- January 2018 and were found to have AAD on computed tomography of the thorax were retrospectively reviewed. There were two groups in the study, one AAD group,and the other healthy volunteers' group. First, thiol and disulfide levels were determined with the spectrophotometric method defined by Erel and Neşelioğlu, natural thiol (NT), total thiol (TT), and disulfide (D) levels, and their ratios were calculated (index 1: D / NT, index 2: D / TT, index 3: NT / TT). We compared these two groups in terms of Oxidative stress parameters.Results: A total of 40 patients with AAD and 38 age-matched healthy volunteers were included in this study. There was no significant difference between the two groups in terms of gender and age (p=0.923, p=0.401, respectively). The AAD group had significantly lower natural thiol and total thiol (p<0.001), but disulfide levels were similar (p=0.360). Oxidative stress parameters were not statistically significant in terms of mortality.Conclusion: We found significantly lower thiol/disulfide homeostasis in patients with AAD, particularly native thiol and total thiol. We think that oxidative stress theory may play a role in the pathophysiology of AAD and oxidative stress parameters may guide the diagnosis.
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Objectives: The aim of this study is to search if using thiol/disulphide homeostasis together with Neutrophile Lymphocyte Ratio (NLR) which are oxidative stress markers in patients who apply to the emergency service with carbon monoxide intoxication is useful regarding diagnosis or not. Materials and Methods: The study was performed prospectively with 45 patients who applied to the emergency service between 01.01.2014 - 01.03.2015 and who were included in the study and 40 healthy persons who were determined as control group. Thiol/disulphide homeostasis parameters (Thiol, disulphide, disulphide / native thiol, disulphide / total thiol, native thiol / total thiol) and NLR which are oxidative stress markers were studied in the patient and control groups by a method which was developed newly by Erel and Neşelioğlu. Results: In persons with carbon monoxide intoxication, a significant difference was detected in NT, TT, index 3 and NLR rates according to the control group. NT, TT and index 3 were found lower in the patient group, and NLR mean values were found higher in the patient group (p =0.005, < 0.001, = 0.032, < 0.001 respectively). Conclusion: To use NLR together with thiol/disulphide homeostasis parameters in the diagnosis of carbon monoxide intoxication is useful regarding diagnosing in these patients.
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Amaç: Geriatrik popülasyonda yaş ile değişen fizyoloji ile birlikte travmaya verilen vücut yanıtı dadeğişmektedir. Skorlama sistemleri birçok hasta grubu ve hastalık üzerinde hastane yatışı gerekliliği ve prognoz tahmini açısından çalışılmaktadır. Bu çalışmada acil servise travma ile başvuran 65 yaş üstü hastaların demografik özelliklerinin belirlenmesini ve travmanın oluş şekli ile birlikte Revize Travma Skoru (RTS) değerlendirilmesini amaçladık.Materyal ve Metot: Çalışma prospektif, kesitsel bir çalışmadır. 01/12/2017- 31/05/2018 tarihleri arasında bir üniversite hastanesi acil servisine başvuran 65 yaş ve üzeri travma hastaları çalışmaya dahil edildi. Hastaların demografik verileri, vital bulguları, fizik muayene bulguları, görüntüleme, laboratuvar sonuçları, eritrosit süspansiyonu (ES) ihtiyacı, hasta sonlanımları ve hastane içi ve 28 günlük mortaliteleri kayıt edildi. Tüm hastaların RTS skorları hesaplandı.Bulgular: Çalışma döneminde acil servise 4898 geriatrik hasta başvurdu. Çalışmaya 229 hasta dahil edildi. Hastalarının 153’ ü (%66,81) kadın olup yaş ortancası 79 (IQR 72-86) bulundu. En sık komorbid hastalık hipertansiyondu (n=109, %47,59). En sık yumuşak doku travması (YDT) (31.87%) ve ikinci sırada femur/kalça kırığı (23,58%) yer aldığı görüldü. Hastaların RTS ortancası 12 olarak bulundu. RTS skorlarına göre hastalar karşılaştırıldığında düşük olan grupta Alzheimer/demans, geçirilmiş inme varlığı, eritrosit süspansiyonu ihtiyacının ve mortalite oranının daha fazla olduğu görüldü (sırasıyla, p<0,001, p=0,002, p<0,001, p=0,002).Sonuç: Günümüzde yaşlı popülasyonun travmaya maruz kalma olasılığı yükselmektedir. Çalışmamızda hastaların en sık mekanik veya non mekanik düşme nedeniyle acil servise başvurduğu en sık gözlenen yaralanma bölgesinin ekstremite/pelvis olduğunu ve RTS skoru düşük olan grupta Alzheimer/demans ve geçirilmiş inme varlığı, ES ihtiyacının ve mortalite oranının daha fazla olduğu gösterdik.
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BACKGROUND/AIMSThe aim of this study was to investigate the diagnostic utility of thiol/disulfide homeostasis parameters, which are oxidative stress markers, together with the neutrophil-to-lymphocyte ratio (NLR) in diagnosing of urinary tract infections (UTI) in the emergency department (ED).MATERIAL and METHODSThe study was conducted prospectively and included 63 patients who were admitted to the ED between May 15th, 2018, and October 1st, 2018, and 59 healthy subjects included as the control group. A new method developed by Erel and Neşelioğlu was used to measure the thiol/disulfide homeostasis parameters (thiol, disulfide, disulfide/native thiol, disulfide/total thiol, native thiol/total thiol), and the NLR was studied in the patient and control groups. In addition, the relationship between these parameters and the body temperature and urinary cultures in patients with UTI was investigated as well.RESULTSThe NLR, disulfide/native thiol, and disulfide/total thiol mean values were found to be significantly higher (p<0.001, 0.013 and 0.009, respectively) in patients with a UTI compared to the control group. Disulfide, disulfide/native thiol, and disulfide/total thiol mean values were found to be significantly higher (p<0.001, <0.001 and <0.001 respectively) in the group with a high body temperature compared to the group without high temperature. Native thiol and total thiol values were found to be significantly lower (p=0.048 and 0.020, respectively) in the group with a positive urine culture compared to the group with a negative urine culture.CONCLUSIONThiol/disulfide homeostasis parameters together with the NLR values are diagnostically useful in patients with UTI.
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